Question 1

Which of the following are causes of orthostatic hypotension?

Accepted Answer

Diuretics, pregnancy, burns, excessive heat exposure are causes of orthostatic hypotension. The causes of orthostatic hypotension include dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat exposure, large varicose veins, and certain neurological disorders. Drugs that can lead to orthostatic hypotension include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and antidepressant.

Question 2

Which of the phenomena is matched correctly with the relevant of general adaptation syndrome?

Accepted Answer

The correct match is Alarm stage - initial response to a stressor. The alarm stage is the initial response to a stressor, which is the fight or flight syndrome. The stage of resistance or adaptation is the process whereby the individual continues the fight or flight response. The stage of exhaustion is the point at which the stressor becomes dysfunctional and can lead to disease or illness.

Question 3

An 80-year old hypertensive male is on regular antihypertensive medication, complaints of dizziness, fatigue, syncope or fainting, mental confusion, and lightheadedness after eating meals. The attending nurse records a postprandial fall in blood pressure. What is the appropriate advice to be given by the nurse to help his condition?

Accepted Answer

The appropriate advice given by the nurse is to tell him to eat small meals low in carbohydrates. Postprandial hypotension is a condition that involves a sudden drop in blood pressure after eating. It typically affects elderly individuals with other cardiovascular comorbid condition or neurological disorders. Symptoms of the condition include dizziness, fatigue, syncope or fainting, mental confusion, and/or lightheadedness. Postprandial hypotension is more common among individuals with high blood pressure or autonomic nervous system disorders. Lifestyle modifications such as eating smaller meals low in carbohydrates more often may reduce symptoms. Also, lowering the dose of blood pressure medications may decrease the onset of postprandial hypotension.

Question 4

When ventricular fibrillation occurs in the coronary care unit, the immediate action is to:

Accepted Answer

The immediate action for a patient of ventricular fibrillation is to defibrillate the patient. Ventricular Fibrillation is an emergency. The immediate action is to give 1 shock - Manual biphasic typically 120 J-200 J; Monophasic 360 J and then resume CPR.

Question 5

A patient is taking Lisinopril 10mg. The nurse knows that the desired effect for this medication would be to?

Accepted Answer

The desired effect of this medication would be to decrease the blood pressure. Lisinopril is an ACE inhibitor drug which decreases blood pressure. Common adverse effects of this drug would include: hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea and renal impairment.

Question 6

The nurse is assessing a patient suspected to have myocardial infarction. Which of the following questions is a priority?

Accepted Answer

The priority question should be "When did these symptoms start?" The nurse must be able to identify the onset of symptoms and this should be a priority during assessment. It is important to know the details when the symptoms started, since the patient's symptoms of MI will be considered for thrombolytic therapy provided that they started no longer than six hours prior.

Question 7

An 80-year-old female patient presents with tender painful knee joints. Which of the following pharmacologic agents may be useful in treatment of her condition?

Accepted Answer

Pharmacologic agents used to treat inflammation include anti-inflammatory agents, corticosteroids, anti-malarial agents such as hydroxychloroquine and other agents including methotrexate, sulfoalanine, leflunomide, anti-tumor necrosis factor medications, cyclophosphamide and mycophenolate. Pharmacologic agents used to treat joint pain and inflammation mainly are corticosteroids and NSAIDs.

Question 8

A 45-year-old male patient has waist circumference of 105 cm. His blood examination shows fasting plasma glucose of 120mg/dL, triglyceride levels 180 mg/dL, high-density lipid cholesterol 30 mg/dL. He is at risk of developing which of the following set of conditions?

Accepted Answer

The NCEP/ATP III (National Cholesterol Education Program/Adult Treatment Panel) defines metabolic syndrome as an individual with 3 or more of the following risk factors including waist circumference equal to or greater than 102 cm in men and 88 cm in women, triglyceride levels greater than 150 mg/dL, high-density lipid cholesterol less than 40 mg/dL in men and less than 50 mg/dL in women, blood pressure greater than or equal to 130/85 mmHg and fasting plasma glucose greater than 100mg/dL.
Additional conditions that have been associated with metabolic syndrome include fatty liver, polycystic ovary syndrome, gallstones and sleep apnea.

Question 9

A patient presenting with symptoms of shortness of breath on exertion, swelling of abdomen and extremities, decreased appetite, nausea was diagnosed to have congestive heart failure. What should be the goal of treatment in this patient?

Accepted Answer

The goal of treatment in patients of congestive heart failure includes controlling excess fluid accumulation, improving cardiac function and reducing cardiac workload

Question 10

A postoperative surgical patient develops pain, redness, and edema in the calf. These symptoms may potentially indicate which of the following conditions?

Accepted Answer

Pain, redness, and edema in the calf of a postoperative patient indicates thrombophlebitis, resulting from venous stasis. Venous thrombosis (thrombophlebitis) refers to inflammation of a vein precipitating thrombus (blood clot) formation; it almost always occurs in the neck veins or occasionally in the trunk.
Types of venous thrombosis include:
a) Deep Vein Thrombosis (DVT), a stationary clot that forms in the deeper veins of the legs;
b) Superficial thrombophelbitis, an inflammation of a more superficial vein closer to the surface; this condition is accompanied by formation of a stationary clot within the vein. Phlebothrombosis refers to thrombus formation without venous inflammation. Phlebitis refers to inflammation of one or more veins without resultant clot formation. Thrombi formation is believed to occur when both venous stasis and hypercoagulability exist. Stagnated blood will accumulate in the pocket areas of the vessel valves, resulting in hypercoagulability (because activated coagulation factors are not removed from the blood).
Traces of thrombin activate the clotting mechanisms of platelet aggregation and conversion of fibrinogen to fibrin. Trauma or damage to the vessel walls from an injury or phlebitis may cause platelet adhesion to the vein wall. DVT and phlebitis are acute diseases that may result in pulmonary embolism (as pieces of the clot break off and travel to the lung) or chronic venous insufficiency.

Question 11

A 64-year old male patient was advised to undergo coronary artery bypass surgery after coronary angiogram. What is the correct statement used by the nurse while explaining the objective of coronary artery bypass surgery?

Accepted Answer

The correct statement used by nurse while explaining the objective of coronary artery bypass surgery is "Complete revascularization of the myocardium". The objective of CABG is complete revascularization of the myocardium. Arteries with severe stenoses (> 50% diameter reduction) are bypassed, except those of small calibre (< 1mm in diameter).

Question 12

Choose the statement which is correct about intermittent claudication:

Accepted Answer

The correct statement about intermittent claudication is "Intermittent claudication is defined as pain in muscles during physical activity which resolves once activity is stopped". The condition is defined as muscle pain or cramping in appendages triggered by walking and physical activity. Individuals may also experience ischemic rest pain. The condition occurs after physical exertion and consists of pain during physical activity, which resolves once the activity is stopped. The pain most commonly occurs in the calves, thighs, and/or buttocks.

Question 13

Which of the following terms correctly defines the character of pericardial friction rub?

Accepted Answer

The character of pericardial friction rub is a scratchy sound like velcro. Rough rumbling sound is produced by stenotic murmurs such as murmur of mitral stenosis. Soft cooing sound may be heard in some cases of aortic regurgitation.

Question 14

A patient presenting to emergency room with severe dyspnoea is diagnosed to have pulmonary edema. Which of the following drugs should the nurse immediately prepare to give this patient?

Accepted Answer

The nurse should immediately prepare intravenous furosemide at a higher dose to give this patient. In case of acute pulmonary edema, treatment with intravenous nitrates (glyceryl trinitrate), and high ceiling diuretics, such as furosemide or bumetanide, is the mainstay of therapy. These improve preload and afterload and help to improve cardiac function.

Question 15

An 80-year old male is having end-stage aortic stenosis. Definitive treatment for his condition is aortic valve replacement but he is critically ill and surgery cannot be performed at the moment. Which surgical procedure can be used as a bridge to aortic valve replacement surgery in this patient?

Accepted Answer

Balloon valvuloplasty is done for critically ill patients with end-stage aortic stenosis as a "bridge" to aortic valve replacement. Decalcification/debridement is considered in patients with mild to moderate AS in whom the primary indication for surgery is coronary artery disease. Commissurotomy is useful in a small percentage of patients with aortic rheumatic valve disease with a trileaflet valve and minimal to no calcification.

Question 16

Which of the following diagnostic tests should be done for a patient who wants to be screened for presence of valvular heart disease?

Accepted Answer

Electrocardiogram, echocardiography and chest x-ray should be done to screen a patient for presence of valvular heart disease. Diagnostic tools used to screening for valvular diseases include electrocardiogram, echocardiography, magnetic resonance imaging, and chest x-ray. Other diagnostic tests to rule out any other co-morbid cardiovascular conditions include cardiac stress testing and cardiac catheterization.

Question 17

A nurse is taking care of a patient with post carotid endocardiectomy. What parameters should the nurse examine in the patient for neurological assessment in 1 to 2 hour post-op period?

Accepted Answer

The nurse should examine the following parameters in the patient for neurological assessment in 1 to 2 hour post-op period: level of consciousness, vocal cord functioning, reflexes, motor strength, level of sensation, pupil size, and reaction to light. Neurological should be made every 1 to 2 hours to ensure the patient is stable.

Question 18

Which of the following statements about Dressler's syndrome is not correct?

Accepted Answer

The statement that is not correct about Dressler's Syndrome is it is a result of infection of myocardium which extends to pericardium.
Dressler's syndrome:
Post-MI: acute (direct extension of myocardial inflammation, 1-7 days), Dressler's syndrome (autoimmune, 2-8 weeks).

Question 19

A child having aortic regurgitation has been advised for valve replacement surgery. The parents are concerned to know about the type of aortic valve prosthesis which is suitable for their child. What is the correct answer given by nurse?

Accepted Answer

The nurse should tell them that pulmonary autograft is suitable for their child. Pulmonary autograft valves are ideal for children and young adults to avoid anticoagulation. Ross procedure: replace the diseased aortic valve with the patient's own pulmonary valve and implant a semilunar valve homograft (e.g. pulmonary valve homograft) in the pulmonary position.

Question 20

A 42-year old male patient is being discharged from hospital after a mitral valve replacement surgery with a metallic valve. He has been prescribed warfarin. Teaching about which of the following things should be given priority by the nurse?

Accepted Answer

Teaching about using the electric shaver should be given priority by the nurse for this patient. Warfarin is an anticoagulant and one of the major side effects is bleeding. Safety razor involves risk of bleeding through cuts. Missed doses should not be compensated by taking the dose at next scheduled time as this increases the risk of bleeding. It is not necessary to take this drug before meals.

Quiz 2: Cardiac